Blacks Research Articles

Film intervention increases empathic understanding of formerly incarcerated people and support for criminal justice reform

Nuanced portrayals of stigmatized groups in media have been shown to reduce prejudice. In an online experiment (N = 749), we tested whether a feature film depicting incarcerated peoples' experiences in the criminal justice system can increase a) empathic accuracy and compassion toward people who have been incarcerated and b) support for criminal justice reform. We measured baseline empathic accuracy via a well-validated task, where participants infer the emotions of people sharing stories about difficult life events. All storytellers were formerly incarcerated and students. However, in half the videos we labeled them as "formerly incarcerated" and in the remaining half as "college student." We then surveyed people's baseline attitudes toward criminal justice reform. Next, we assigned participants to watch one of three films. The intervention film chronicled the true stories of Black men on death row. Two docudramas of similar length served as control films. Finally, participants completed the empathic accuracy task and survey again and were given the opportunity to sign a petition. Compared to those who watched a control film, participants who watched the intervention film more accurately inferred the emotions of storytellers labeled "formerly incarcerated," and increased their support for criminal justice reform. These effects held for conservative and liberal participants alike. However, the film had no effect on feelings of compassion. Together, these results demonstrate the power of narrative interventions to not only increase empathic accuracy for members of a severely stigmatized group, but to increase support for reforms designed to improve their lives.

Understanding the Difference Between Autism and the Autistic Spectrum: A Focus on the South African Context

Autism is a group of severe developmental disorders with impairments beginning before 30 months of age and characterized by a qualitative disturbance of social development and of language for communication, a stereotyped behaviour, and a lack of a broad set of interests. The expression of autism varies from one individual to the next. It is a communicative disorder and is not due to poor reception. The researchers drew their literature from reputable journal articles, book chapters from established publishers, and informal community conversations amid the researchers’ experiential intuition. Currently, South African children with autism spectrum disorder (ASD) lack government support structures and rely primarily on families for assistance with education and therapy. An additional challenge is that in some South African black communities, autism is not recognized as a disorder. A study exploring differences in the nature, application, experience, and examination of social awareness and understanding of selected educators about new terminology in their environment found that local black teachers had less exposure to autism knowledge, diagnosis, treatment, and prognosis in their communities, and little understanding, awareness, or acceptance of this condition. This article underscores the crucial role of social service professionals, such as psychologists, registered counsellors, social workers, etc, in these communities. Their presence and active involvement provide hope in these challenging times. It recommends that they conduct psychotherapeutic education, which could involve awareness campaigns and counselling about psychotherapeutic education. Their role would be to provide support, guidance, and education to the community members, helping them to build their resilience to fight the coronavirus.

Racial disparities in prostate cancer in the UK and the USA: similarities, differences and steps forwards.

In the USA, Black men are approximatelytwice as likely to be diagnosed with and to die of prostate cancer than white men. In the UK, despite Black men having vastly different ancestral contexts and health-care systems from Black men in the USA, the lifetime risk of being diagnosed with prostate cancer is two-to-three times higher among Black British men than among white British men and Black British men are twice as likely to die of prostate cancer as white British men. Examination of racial disparities in prostate cancer in the USA and UK highlights systemic, socio-economic and sociocultural factors that might contribute to these differences. Variation by ancestry could affect incidence and tumour genomics. Disparities in incidence might alsobe affected by screening guidelines and access to and uptake of screening. Disparities in treatment access, continuity of care and outcomes could contribute to survival differences. In both localized and metastatic settings, equal access could diminish the observed disparities in both the USA and the UK. An understanding of behavioural medicine, especially an appreciation of cultural beliefs about illness and treatment, could inform and improve the ways in which health systems can engage withand deliver care to patients in minoritized groups affected by prostate cancer. Methods of promotingequity include targeting systemic barriers including systemic racism,proportional recruitment of patients into clinical trials, diversifying the health-care workforce and facilitating care informed by cultural humility.Actively engaging patients and communities in research and intervention might enable the translation of research into increasingly equitable care for patients with prostate cancer in the UK, the USAand globally.

Using a Phenomenological and Fanon Analytic: A Methodological Framework and Method for Research with Impoverished Black Male Youth

While there is a good amount of general literature on the experiences of Black men in Canada, there is a paucity of empirical data regarding the specific lived experiences of first- and second-generation, Canadian-born, impoverished Black young men (ages 15–29). Black male youth are often impoverished due to anti-Black racism and classism, which together further social and economic barriers. While many methods of data collection and analysis provide a useful snapshot of the experiences of young Black men, many traditional methods are unable to highlight the nuance that lies in complex intersections of identity for Black young men experiencing poverty and un(der)employment. This article demonstrates the success of practices rooted in phenomenology to understand and articulate the unique, heterogeneous lived experiences of first- and second-generation impoverished Black young men who utilize youth employment training programs in three Canadian cities. Further, this article demonstrates how using Frantz Fanon’s scholarly work and applied phenomenology can inform future research on Black and other underserved youth who face complex marginalization.

"First, Trust Needs to Develop": Hematologists' Perspectives on Factors Influencing Black Persons' Participation in Clinical Trials.

Cancer clinical trials are crucial for treatment standards and innovation but lack racial-ethnic diversity. Understanding physician perspectives on recruiting participants is critical due to their role in decision-making about trial candidacy and enrollment. From August 2021 to January 2022 we recruited 13 Academic hematologists experienced with treating blood cancers and enrolling clinical trial participants. Each hematologist participated in a 60-75-minute semistructured interview and completed a sociodemographic survey. Using the National Institute on Minority Health and Health Disparities multilevel model as a framework, we characterized hematologists' perceived barriers to clinical trial participation among Black persons. ATLAS.ti v9 and later v 23.2.1 was used for project management and to facilitate data analysis using the Sort and Sift, Think and Shift approach (ResearchTalk Inc). All hematologists were White, with 70% being male. Three factors influenced their perspectives on enrolling Black individuals in clinical trials: individual attitudes and beliefs, such as perceptions that Black or socioeconomically disadvantaged persons will be less willing or less compliant with the requirements for trial participation and follow-up. The need to build trusting relationships between themselves and patients prior to discussing clinical trials and the prevailing legacy of medical mistrust among the Black community. Trust was found to be the underlying factor in determining communication between hematologists and Black persons about clinical trials across all three levels. This study highlights how hematologists' attitudes, beliefs, biases, and views on trust in patient relationships influence their communication with Black individuals about clinical trials. It emphasizes the need for further research to develop interventions that address the lack of racial and ethnic diversity in trials.

Altered RBC deformability in diabetes: clinical characteristics and RBC pathophysiology

BackgroundReduced red blood cell deformability (RBCD) is associated with diabetic vascular complications, but early pathophysiological RBC changes and predictive demographic and clinical factors in populations with diabetes are unclear. An understanding of early diabetes-specific RBC changes associated with impaired RBCD is essential in investigating mechanisms that predispose to diabetic vascular complications.MethodsWe conducted an outpatient cross-sectional study of participants in a well-controlled diabetes cohort (N81) and nondiabetic controls (N78) at the National Institutes of Health. First, between-group differences in RBCD measures were assessed with shear stress-gradient ektacytometry. Differences in structural RBC parameters were assessed using osmotic gradient ektacytometry and NaCl osmotic fragility. Functional RBC changes were assessed using hemoglobin-oxygen dissociation: p50.ResultsAll shear-stress gradient RBCD measures were significantly altered in the diabetes cohort vs. nondiabetic controls, even after adjustment for confounding covariates (p < 0.001). Adjusted for diabetes-status and demographic factors, significant predictors of reduced RBCD included older age, Black race, male gender, hyperglycemia, and vascular complications (all p < 0.05). Reduced RBCD was also associated with aberrant osmotic-gradient parameters, with a left-shift on osmotic gradient profile indicative of dehydrated RBCs in diabetes. A structure-function relationship was observed with reduced RBCD associated with reduced osmotic fragility (P < 0.001) and increased hemoglobin-oxygen dissociation (P < 0.01).ConclusionsFindings suggest impaired RBCD incurs similar demographic and clinical risk factors as diabetic vascular disease, with early pathophysiological RBC changes indicative of disordered RBC hydration in diabetes. Findings provide strong evidence for disordered oxygen release as a functional consequence of reduced RBCD.Clinical trial number: NCT00071526.

Using the 12-item short-form health survey (SF-12) to evaluate self-rated health in an environmental justice community

The Greater Fifth Ward (GFW) is a Northeast Houston, Texas, neighborhood with a legacy of industrial contamination and a confirmed cancer cluster. To understand self-rated health in the GFW, community-based participatory research (CBPR), was used to promote the inclusion of all partners. CBPR involves the community during each stage of the research process from design to research dissemination. A complete census was conducted, and 114 surveys were obtained in the environmental justice (EJ) community from July to November 2021. EJ communities shoulder an unfair burden of environmental exposures, pollution, and poor built environments. Mental and physical health were measured using the validated 12-item Short Form Health Survey (SF-12v2). We posited that the Black or African American (Black/AA) community would have lower mental composite scores (MCS) and physical composite scores (PCS) compared to the nation and their White counterparts. The MCS and PCS were calculated and compared against the national mean. Overall, participants had higher MCS and lower PCS than the national mean. Black/AA males and females had lower MCS compared to their White counterparts. White females had the lowest PCS among all respondents, significantly lower than the national average. MCS was lower among those who lived in the neighborhood longer. Burdens from pollution may impact residents’ health and perceived health. Targeted interventions or programs that improve mental or physical health would benefit this community and other inequitably burdened neighborhoods.

Psychosocial components of the U.S. African Caribbean ethnic project and contributing contextual factors

ABSTRACT The ethnic project thesis contends African Caribbean immigrants to the U.S. summon ethnicity in defense against racial characterizations of their group. I examine the psychosocial components of the African Caribbean ethnic project – Caribbean cultural involvement and awareness and distancing from Black awareness and sense of shared fate. Defining the Caribbean ethnic project as a subjective state, I examine potential contributing contextual factors, including perceived discrimination, exposure to all Black contexts, and socioeconomic status (SES). Using the National Survey of American Life, I find increasing SES is positively associated with Black awareness, while increasing exposure to all Black contexts enhances Caribbean awareness and acculturation. However, as time in the U.S. increases, Caribbean awareness declines and a sense of shared fate with Black people grows, particularly among those at low levels of SES. These findings are discussed in terms of the influence of racialization on the U.S. Caribbean ethnic project.

Predictive Ability of the Pedal Medial Arterial Calcification Score for Major Adverse Limb Events Among Patients with Chronic Limb-Threatening Ischemia

ObjectivePedal medial arterial calcification (pMAC) is a potential predictor of major adverse limb events (MALE) among patients with critical limb-threatening ischemia (CLTI). This study aims to validate the prognostic value of the pMAC score in predicting major lower limb amputation (MLLA) and need for re-do revascularisation. MethodsA single centre study involving 196 patients diagnosed with CLTI, reviewed between 2012 and 2022. Patients’ pMAC scores were obtained through X-ray assessments. Correlations between pMAC scores and the incidence of MALE and re-do revascularisation, were analysed. A power analysis using G* Power 3 software determined a needed sample size of 157 participants. Statistical analysis employed SPSS 26, utilising descriptive statistics, Chi Square, Mann-Whitney, Kaplan-Meier with log-rank test, and Cox regression for predictor identification. ResultsThe cohort was predominantly male (79.1%) and diabetic (59.2%). Re-do revascularisation need was 15.3%, increasing with pMAC scores: 3.3% (low), 24.5% (medium), and 50% (high) (p<0.001). MLLA frequency also rose with pMAC scores: 6.7%, 27.5%, and 50% respectively (p<0.001). Higher pMAC scores correlated with a higher incidence of MALE (p=0.029). Multivariate analysis showed medium pMAC (HR 4.159, p=0.002), high pMAC (HR 7.366, p=0.015), and GLASS stage 3 (HR 3.529, p=0.011) as independent MLLA predictors. Re-do revascularisation predictors included female sex (HR 2.106, p=0.063), Black race (HR 64.498, p=0.001), medium pMAC (HR 6.812, p=0.002), high pMAC (HR 11.455, p=0.008), and GLASS stage 3 (HR 2.899, p=0.037). ConclusionThe pMAC score effectively predicts MALE in CLTI patients and enhances risk stratification. Using both, pMAC scores and GLASS stages enhances predictive accuracy, identifying patients at higher risk for MLLA, Informing clinical decision-making and therapeutic strategies.

Imaging, Pulmonary Function, and Histopathologic Findings of Persistent Fibrosis in a Longitudinal Cohort Three Years after Severe COVID-19 Infection.

Fibrotic-like abnormalities are present in 60% of a single-center, longitudinal, multi-ethnic cohort 3-years after severe COVID-19. They are independently associated with male sex, low BMI, shorter telomere length, increased severity of illness, and mechanical ventilation; Black race and asthma are protective. Participants with fibrotic-like abnormalities are more likely to have reduced diffusion capacity and 6-minute walk distance. Fibrotic-like abnormalities persist but modestly improve over time. Transbronchial biopsies show small airways histopathology, consistent with high prevalence of air trapping in expiration, and infrequent interstitial thickening. This study highlights the need for continued monitoring of patients with persistent fibrosis after severe COVID-19.

Xenophobia as the major plight of African immigrants in South Africa: the example of Epiphanie Mukasano's selected poems

ABSTRACT The attacks on African immigrants in South Africa have generated a lot of media attention both within and outside the country. This issue has not yet garnered enough critical attention in the field of literature, especially poetry. The purpose of this research is to analyse selected poems from Epiphanie Mukasano's collection Kilimanjaro on My Lap (2010) that discuss the hardships of African immigrants in South Africa. For the purposes of this study, this research uses migration theory. The research finds that racism and xenophobia are to blame for the country's immigration issues in the poems selected for the study. Asserting that the majority of immigrants are seeking protection due to upheaval in their home countries, Mukasano implores those who commit abhorrent acts of xenophobia and racism to have mercy on the immigrants. Consequently, Mukasano's answers to xenophobic assaults in the selected poems are addressed in this study. Mukasano makes an attempt to persuade the perpetrators of racism and xenophobia in South Africa that Pan-Africanism ought to be seen as a brotherhood rather than an enemy. Poems by Mukasano generally focus on the critical observation of people and their attitudes towards immigrants in general, regardless of their status, as well as the challenging consequences faced by black people. Protest poetry by Mukasano is vocal and engaged in challenging the status quo. Her tone, style, and use of poetic forms, which show how she gets her message across, show that she accomplished this successfully.

Imposter Syndrome: A Reflective Discourse into the Experiences of Canadian Black Nurses through Art.

Impostor syndrome is a common phenomenon experienced by individuals when entering new ranks in the workplace. Although women experience greater feelings of imposter syndrome than men, Black individuals report a prolonged experience of imposter syndrome when compared to their white counterparts, which negatively impacts their everyday experiences, health, and overall well-being. With growing studies showing the pervasive nature of anti-Black racism on the health of Black people, there remains a paucity of studies showing the connection between anti-Black racism and imposter syndrome. Within nursing, anti-Black racism can be seen to foster imposter syndrome through discriminatory practices that affect the career development, recruitment, and retention of Black nurses. Anti-Black racism is prevalent, and, in this paper, two Black nurses share insight through their own encounters with imposter syndrome and its relationship with anti-Black racism. Guided by Black feminist thought, they use art to navigate their reflective discourse as a means of reclaiming their identity and positionality as leaders in their rights. Reflective discourse is ideal for transformative learning to occur through dialogue. In addition, it promotes the use of art for deeper discussions when understanding the Black experience. Together, these nurses explicate how adopting Afrocentric knowledge and practices through their reflective discourse can affirm their identity, promote a sense of belonging, and assist in dismantling the effects of anti-Black racism and imposter syndrome within nursing.

Disparities in Heart Failure Deaths among Patients with Cirrhosis

Background: Heart failure deaths have increased in recent years in the United States and are projected to continue to increase in the future. Rates of liver disease and cirrhosis have similarly increased in the United States. Patients with cirrhosis are at an elevated risk of heart failure with a worsened prognosis. As such, investigations of the epidemiology of these comorbid conditions are important. Methods: We obtained data on heart failure deaths among people with cirrhosis in the United States from 1999 to 2020 from the Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research multiple cause of death database. Rates were analyzed for the population as a whole and for demographic subgroups. Results: From 1999 to 2020, there were 7424 cirrhosis-related heart failure deaths. Rates were higher among Black (AAMR ratio = 1.288, 95% CI: 1.282–1.295) and Asian people (AAMR ratio = 3.310, 95% CI: 3.297–3.323) compared to White people. Rates were also higher in rural areas than in urban areas (AAMR ratio = 1.266, 95% CI: 1.261–1.271). Rates increased over time across demographic subgroups. Conclusions: People with cirrhosis are at an elevated risk of heart failure death compared to the general population. Rates were particularly elevated in Asian people, Black people, males, and people living in rural areas. These data indicate a significant and previously underappreciated disease burden. Clinicians taking care of cirrhosis patients should be aware of the risk of heart failure and should collaborate with cardiac specialists as needed.

Social Determinants of Preterm Birth amongst Non-Hispanic Black Individuals.

Non-Hispanic Black individuals are disproportionately affected by preterm birth (PTB), a major driver of the racial disparity in infant mortality in the United States. The objective of this study is to identify indicators of social determinants of health (SDoH) that contribute to preterm birth amongst non-Hispanic Black individuals. Population-based retrospective case-control study of U.S. birth records (2012-2016). Factors potentially associated with PTB and considered indicators of SDoH were compared between singleton live births of non-Hispanic Black individuals delivering preterm (<37 weeks of gestation) and term (≥37 weeks of gestation). Logistic regression quantified the association between SDoH and PTB such as insurance, education, and prenatal care visits and reported as odds ratios (ORs; 95% confidence interval, CI). Of 2,763,235 live births to Black individuals, 340,480 (12%) occurred <37 weeks of gestation. Factors most strongly associated with PTB (p < 0.001), presented as OR (95% CI), included no prenatal care 3.0 (95% CI: 2.9-3.1) or insufficient prenatal care 2.7 (95% CI: 2.7-2.8), smoking during pregnancy 1.4 (95% CI: 1.43-1.47), unmarried 1.18 (95% CI: 1.17-1.19), lack of high school diploma 1.1 (95% CI: 1.12-1.40), lack of father of baby listed on birth certificate 1.22 (1.21-1.23), and Black paternal race 1.10 (1.08-1.12). Receipt of WIC (women, infants, and children) during the pregnancy had a protective effect on PTB risk in Black individuals, OR 0.83 (0.83-0.84). Pregnancies in Black individuals who are ≥35 years old, smoke tobacco, utilize Medicaid insurance, have less than a high school education, are unmarried, have little to no prenatal care, Black paternal race, and lack of father of baby listed on birth record had increased risk of PTB. Understanding the lived experience of Black pregnant people and these selected indicators of SDoH that contribute to the risk of PTB may inform development of interventions to address the racial disparity in PTB in the United States. · Preterm birth disproportionately affects Black individuals.. · SDoH are contributors to preterm birth.. · This study investigates social determinant influences on preterm birth among Black individuals..

Pathologist Interrater Reliability and Clinical Implications of Elevated Donor-Derived Cell-Free DNA beyond Heart Transplant Rejection

BackgroundThere is significant variability amongst pathologists in the histopathological interpretation of the endomyocardial biopsy (EMB) for acute cellular rejection (ACR) and assessment of variability in the interpretation of antibody-mediated rejection (AMR) has not been reported. In contemporary practice, the strategy of allograft surveillance with donor-derived cell-free DNA (dd-cfDNA) as compared to EMB has not been compared with a focus on long-term clinical outcomes beyond acute rejection (AR). MethodsThe Genomic Research Alliance for Transplantation (GRAfT) is a multicenter, prospective cohort study that enrolled patients from 2015 to 2020. The center pathologist read was compared to two blinded core cardiac pathologists. ACR and AMR were graded based on the International Society for Heart and Lung Transplantation (ISHLT) criteria. Weighted Cohen’s kappa (κ) was used to evaluate interrater reliability between the center and core reads. To assess long-term outcomes, we evaluated a composite of AR, allograft dysfunction, and mortality within 1 year. ResultsThe study included 94 patients (median age 55 years [IQR 45, 62]), 30% female, 41% Black race) with a total of 429 EMBs and paired dd-cfDNA measures. The concordance rate between center and core pathologists was 77% for ACR (95%CI: 66% - 89%) and 63% for AMR (95%CI: 53% - 74%). 46 patients had an elevation in dd-cfDNA without AR by EMB. The median dd-cfDNA was 0.49% (IQR: 0.35, 1.01) and subsequent AR, allograft dysfunction, or mortality occurred in 59% of these patients at 1 year. In patients with AR by EMB and negative dd-cfDNA (n=5) the composite outcome occurred in 20% of patients at 1 year. At baseline, the positive likelihood ratio (LR+) of dd-cfDNA to detect AR by the center pathologist was 3.74 (95% CI 3.01 - 4.64) and core pathologist was 2.59 (95%CI: 1.95 - 3.45). If the composite outcome was included as a true positive, the LR+ of dd-cfDNA improved to 9.82 (95%CI: 7.04, 13.69) and7.63 (95% CI: 5.61, 10.38) at 1-year, respectively. ConclusionsPathologists interrater reliability is limited in both ACR and AMR. The positive LR of dd-cfDNA when compared to traditional histopathology is limited, but when longitudinal clinical outcomes are included to assess diagnostic performance, the LR+ improves significantly. The value of dd-cfDNA extends beyond the diagnosis of AR to include other clinically meaningful outcomes for patients after heart transplant.

Safety and Efficacy of Home-Based Walking Exercise for Peripheral Artery Disease

IntroductionHome-based walking exercise is first-line therapy for peripheral artery disease (PAD), but benefits of home-based walking exercise are variable. This study evaluated whether specific clinical characteristics were associated with greater improvement after home-based walking exercise or with higher rates of serious adverse events (SAEs). MethodsData were combined from two randomized clinical trials comparing home-based walking exercise to control in PAD. The home-based exercise interventions used behavioral interventions to help participants adhere to exercise. The primary outcome was the proportion of PAD participants who improved 6-minute walk (6MW) by at least 20 meters. Serious adverse events consisted of overnight hospitalizations or death that occurred during the randomized clinical trial. ResultsOf 376 PAD participants [69.6 years, 54.5% Black, 49.5% women], 217 were randomized to exercise and 159 to control. Home-based exercise improved 6MW by at least 20 meters in 100 (54.9%) participants, compared to 37 (28.0%) in control (Odds Ratio 3.13 (95% CI: 1.94,5.06), P< 0.001. Age, sex, race, comorbidities, baseline 6MW, and income did not significantly alter the effect of home-based exercise on improved 6MW. SAEs occurred in 28.1% and 23.3% of participants randomized to exercise and control, respectively (p=0.29). There were statistically significant interactions, indicating that home-based exercise increased SAE rates, compared to control, in Black compared to non-Black participants (P interaction <0.001), in those with vs. without coronary artery disease (CAD) (P interaction<0.001), and in people with vs. without history of heart failure (P interaction=0.005). ConclusionAmong people with PAD, home-based exercise improved 6MW by at least 20 meters in 54.9% of people. Older age, female sex, Black race, and specific comorbidities were not associated with lower rates of attaining meaningful improvement in 6MW following home-based exercise. Further study is needed to establish whether certain patient characteristics, such as history of coronary artery disease, may affect SAE rates in PAD patients participating in home-based exercise.

Contextualizing Attitudes About Violence from the Vantage Point of Street-Identified Black Male Youth: The Role of the Perceived Neighborhood and Bypassing Adolescence in the Development of Black Masculinity

Using Street Participatory Action Research (Street PAR), we examined the role of subjective neighborhood quality in bypassing adolescence (through adultification) and pro-violence attitudes among Black male youth. One hundred and thirty-seven street-identified, Black adolescent males (M/SD age = 18.07/1.66) were recruited using snowball sampling through social networks of individuals who identified as “street” or engaged in illegal activity. Respondents reported on neighborhood quality, bypassing adolescence, and pro-violence attitudes. Results showed that poorer perceived neighborhood quality correlated positively with bypassing adolescence and pro-violence attitudes. Bypassing adolescence mediated the association between neighborhood quality and pro-violence attitudes. Thus, street-identified Black boys who had more negative perceptions of their neighborhoods endorsed more positive attitudes toward violence and greater bypassing adolescence, or perceived adultification through street life. This novel finding contextualizes the development of violence attitudes in this understudied population and may suggest that bypassing adolescence is an important site of resilience within a street-identified Black masculinity framework.

Emergency Care Use During Pregnancy and Severe Maternal Morbidity

Pregnant individuals who repeatedly use emergency care during pregnancy represent a population who could be disproportionately vulnerable to harm, including severe maternal morbidity (SMM). To explore patterns of unscheduled care visits during pregnancy and ascertain its association with SMM at the time of birth. This cohort study used data from a statewide database that linked hospital records to births and fetal deaths occurring between October 1, 2002, and March 31, 2020, in Massachusetts. Pregnant individuals experiencing births or fetal deaths during the study period were included. Data analysis was conducted from June 2022 to September 2024. The exposure was 4 or more cases of emergency use, defined as either an emergency department visit or observational stay during pregnancy not resulting in hospital admission. Pregnancy episode was ascertained by subtracting the gestational age at birth from the date of birth. The outcome of interest was the odds ratio (OR) for SMM at the time of birth. The algorithm includes 20 conditions or procedures (excluding transfusion) identified through International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes across the study period. A total of 774 092 pregnant individuals (mean [SD] age, 31.2 [5.8] years; 16.8% Hispanic, 9.3% non-Hispanic Asian or Pacific Islander, 9.5% non-Hispanic Black, 63.1% non-Hispanic White) with emergency care visits during the pregnancy were included; 31.3% of these individuals had at least 1 visit. Overall, 18.1% had 1 visit and 3.3% had 4 or more visits. Four or more unscheduled visits were common among those younger than age 25 years (8.7%), with Hispanic (5.7%) or non-Hispanic Black (4.9%) race and ethnicity, with public insurance (6.5%), or with a comorbidity (19.0%) or an opioid use-related hospitalization (26.8%) in the year prior to pregnancy. Of those with 4 or more unscheduled visits, 43.8% visited more than 1 hospital during pregnancy. In a multivariable analysis of the likelihood of SMM, those with 4 or more unscheduled visits had an adjusted OR of 1.46 (95% CI, 1.29-1.66) compared with those with 0 visits. This cohort study found that high emergency care use during pregnancy was associated with an increased risk for SMM. With a significant proportion of those with frequent unscheduled visits also using multiple hospitals, solutions that are community-based and integrated across health systems may be most beneficial.

A Critical Analysis of Cremation Burials Within Some of the South African Tribes: A Contextual Practical Theological View

The colonial erosion of African traditional and cultural practices continues to dislocate the African identity in different ways. The changes and shifts made to burial practices have simply paved a way for the colonial agenda to bring about more Western ways of doing things, burial rites included. It is important to note that cremation, as another way of burying the dead, is slowly becoming a norm for black people. This paper intends to not only unveil the causes and contestations around cremation burials, but to also seek an African theological response as a way to guide black African culture moving forward.

Development of a pharmacy-based HIV PrEP service delivery intervention for Washington, District of Columbia (DC): A study protocol.

Pharmacy-based PrEP service delivery models can help address many of the barriers that inhibit the uptake of PrEP. In an increasing number of states, legislation has been passed, or is under consideration, to allow pharmacists to initiate PrEP without a prescription from a physician or other prescriber. However, there is not yet legislation in Washington, DC to allow pharmacy-based PrEP despite its potential to curb new cases of HIV, which disproportionately affect the Black community in the area. The DC Ends HIV Plan has a goal of less than 130 new cases of HIV per year by 2030, which would require that over 13,000 high-risk residents use PrEP. However, in 2021 only 6,724 Washingtonians were taking PrEP. This study seeks to address the absence of critical formative research into the factors that would influence the implementation of pharmacy-based PrEP in Washington DC using the Implementation Mapping (IM) framework. A needs assessment will be conducted through in-depth interviews (IDIs) with pharmacists (n = 6), PrEP providers (n = 6), current PrEP users (n = 6), DC Department of Health officials (n = 2), DC Board of Pharmacy officials (n = 4) and pharmacy-based PrEP experts (n = 4) to provide input on the operational aspects of pharmacy-based PrEP model as a strategy to increase PrEP uptake. Information gathered through this needs assessment will be used to develop standard operating procedures for the introduction of pilot pharmacy-based PrEP into community-based retail pharmacies.